Tyler John Stevens, PharmD
Pharmacist, Ambulatory Care in Brainerd, MN. Individual provider (NPI-1).
NPI number1629630488
StatusActive
Last updated in NPPESSep 1, 2021
Details
- NPI
- 1629630488
- Entity type
- Individual (NPI-1)
- Name
- Tyler John Stevens
- Credential
- PharmD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 2, 2019
- Certification date
- Sep 1, 2021
- Last updated
- Sep 1, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1835P2201X | Pharmacist, Ambulatory Care | 124294 | MN | Yes |
| 183500000X | Pharmacist | 124294 | MN |
Practice location
2024 S 6th StBrainerd, MN 56401-4529
Phone 218-828-7101
Mailing address
2024 S 6th StBrainerd, MN 56401-4529
Phone 218-828-7101
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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